Trendsetters and social change

Summary of Week 4 of Social Norms, Social Change II (Coursera – University of Pennsylvania & UNICEF)

A person’s choice to abandon a norm depends on their sensitivity to the norm, their risk sensitivity, their risk perception and how many others are following the norm.

One of the requirements of successful norm change is first-movers willing to spark the change. What makes a person a first mover? First movers are people with very low thresholds who are willing to defy the established norm. They: have low sensitivity to the norm (i.e. does not care about the norm); are autonomous in their decision making, and; have a low perception of the risk.

There exists a network of social relations, and the structure of these networks may determine whether deviant behaviour will or will not produce a social change. With increasing abandonment, increasingly more people are likely to abandon the norm. This is because the perception of the risk involved decreases. This continues until a tipping point is reached. However, if there is a big gap between the trendsetter threshold and other peoples’ thresholds, failed diffusion will occur and the new behaviour dies out.

Coordination mechanisms for empirical expectations to induce behaviour change include the media, trusted government mandate and a public commitment.

Norm abandonment

Summary of Week 3 of Social Norms, Social Change II (Coursera – University of Pennsylvania & UNICEF)

For change to occur, having shared reasons that are independent of social expectations is a necessary precondition. This is accompanied by a change of personal normative beliefs. Reasons why a norm is accepted includes: (1) people not seeing the norm as a problem; (2) people may not know that there are alternatives, and; (3) due to pluralistic ignorance. Interventions to change beliefs must be suitable to the underlying causes.

However, deviating from the norm invites negative consequences, thus people will not act alone. This implies that there must be a collective change of expectation, and a coordinated change in behaviour.

Tools for change include media, legislative interventions, economic incentives, educational campaigns and group deliberations. All the tools make people aware that they are being exposed to the same message, but collective discussions has several advantages. During the discussion, the general acceptance of certain arguments becomes visible. It helps to change our personal normative and factual beliefs and to observe that other beliefs are changing too.

Norm creation

Summary of Week 2 of Social Norms, Social Change II (Coursera – University of Pennsylvania & UNICEF)

New norms can emerge in a variety of situations, such as when a common behaviour, manners or etiquette takes up a different meaning. New norms can also emerge in collective action problems, when it generates a negative externality because there is a conflict between individual and collective interest. A norm is more likely to emerge when there is no individual incentive to resolve a negative externality. For example, reciprocity creates a an environment for social trust to fluorish although individuals do not have financial incentives to reciprocate.

There are typically 5 stages in the creation of new norms:

Step 1. Change factual beliefs and personal normative beliefs. In community-led total sanitation, for example, communities are triggered to create disgust that faeces are being transferred to food. Demostrating the consequences of the collective action vividly and immediately illicits a strong emotional reaction that facilitates a decision to change.

Step 2. A collective decision to change. With awareness of the negative externalities, there becomes shared reasons to change behaviour. The decision and subsequent action must be coordinated by everyone in the community or it would not be effective.

Step 3. Introduction of sanctions for non-compliance. Although the collective decision can be very effective, people will soon realise that they are facing a social dilemma because there is a conflict between individual and collective interest. There is an incentive to free ride. Hence, sanctions  through a collective decision of the community to punish trangressors help to broadcast each individual’s personal normative beliefs.

Step 4. Creation of normative expectations. Sanctions update the normative expectations of everyone involved. For instance, when a descriptive norm moves into a domain of signalling group loyalty, it starts to generate normative expectations.

Step 5. Creation of empirical expectations. Normative expectations must be created first, and empirical expectations will follow.

Scripts and schemas

Summary of Week 1 of Social Norms, Social Change II (Coursera – University of Pennsylvania & UNICEF)

Social norms are embedded in a wider web of beliefs, values and other norms.

Schemas are cognitive structures representing knowledge about a particular phenomena, e.g. situations and events. Schema influences a variety of cognitive information, including the perception and interpretation of new information. The closer something is to its prototype (a standard conceptualisation of a particular kind, category or phenomenon), the more likely that schema would be activated. Once a schema is activated, related schemas will also be primed for activation (spreading activation) e.g. gender schemas include empirical and normative expectations about women and men.

Schemas for events or sequences of actions are called scripts. Scripts include roles and rules, as well as expectations about fulfilling the role, and how to react if the accompanying rules are violated.

Schema are supported by the cognitive biases of psychological essentialism, fundamental attribution error and situation of causes, and are maintained by confirmation bias and motivated reasoning. Thus changing behaviours requiring changing at least part of a schema. For example, eliminating domestic violence requires changing shared social schemas and norms that identify a good wife or daughter.

The most prominent models of social change are the bookkeeping model, conversion model and subtyping model which involves encountering discrepant information. However, it should be noted that core beliefs may change more slowly than norms.




Monitoring and evaluating HWTS

Summary of Week 5 of Introduction to Household Water Treatment and Safe Storage (Coursera – École Polytechnique Fédérale de Lausanne)

It is important to understand whether household water treatment (HWT) products are achieving improvements in health (i.e. removing pathogens). Users do not only need access to effective options, but use them correctly and consistently. By testing the products, governments, implementers and funders can be informed of the performance.

Efficacy: The World Health Organisations (WHO) developed global performance standards based on their drinking-water risk-based approach. WHO has a tiered evaluation – highly protective, protective and limited protection – using log removal values of viruses, bacteria and protozoa. Chemical parameters are important but have yet to be developed. It is important to note that WHO measures efficacy (i.e. removal under controlled conditions), not effectiveness (i.e. removal in the real word).

Compliance: The consistent use of HWT is highly context-dependent and can be affected by personal and external factors. Conceptual frameworks to analyse compliance include the RANAS psychological model and IBM-WASH. Compliance is hard to measure.

Health impact: How much can diarrhea be prevented by improving water quality alone? There are significant health gains but it is complicated and expensive to measure. Routine monitoring and evaluation should focus on use before attempting to measure health impact.

Cost-effectiveness: Cost-effectiveness could consider cost benefit (money for money), cost effectiveness (money for DALYs) and willingness to pay (money for HWTS). Cost benefit adds up the costs of the intervention (e.g. meeting the Water MDG target) and weights it against the benefits resulting from the intervention (e.g. reduced diarrheal disease). Cost effectiveness looks only at the cost and considers which approach is the cheapest to achieve a desired outcome. One study found that chlorine and SODIS had the lowest cost.

Often decisions on the use of HWTS technologies are made on the program or government level. Selecting options comprises establishing the context (e.g. water to be treated), defining objectives and assessing the options against objectives. The criteria used is important, and multi-criteria decision analysis can be applied to the selection process.





Implementation models

Summary of Week 4 of Introduction to Household Water Treatment and Safe Storage (Coursera – École Polytechnique Fédérale de Lausanne)

Business models describe how organisations create and capture value. This can be in the form of a nonprofit, social business or for-profit. Business model innovations in water treatment include diversification, water payment methods, cost recovery, and extending distribution channels.

If the goal of household water treatment and storage (HWTS) is to maximise social good, then HWTS should target the most vulnerable populations, such as schools and integrated with health approaches. Healthcare systems are already in contact with the most vulnerable people, and HWTS can increase the efficacy of other health interventions, such as antenatal care and HIV/AIDs.

One role that governments could play is to respect, protect and fulfill the right to water. In the context of HWTS, governments could facilitate access to information on HWTS and the efforts to stakeholders to promote and provide HWTS. Governments could formalise this through national action plans.

Introducing global health

Summary of Week 1 (Part 1) of Essentials of Global Health (Coursera – Yale School of Public Health)

Global health considers the health of populations in a global context, placing priority on improving health and achieving equity in health for all people. This course focuses on the health of poor people in poor countries, issues in public health that transcend national boundaries, and critical public health issues that require global cooperation.

Key perspectives on global health

Determinants of health can be thought of as risk factors and social determinants. A risk factor refers to any attribute, characteristic or exposure of an individual that increases the likelihood of developing a disease or injury while social determinants refer to the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. They can range from individual characteristics to governance, policies and interventions.

Therefore it is important to think broadly. 5 key questions to ask when thinking through a problem to solution are:

  1. What is the problem?
  2. Who is affected?
  3. Why do they get it? Risk factors and social determinants.
  4. Why should we care? Health, social and economic consequences.
  5. What can be done?

The global health context and who plays

Many SDGs targets relate directly and indirectly to health. There are a wide range of different kinds of organisations involved in different kinds of activities:

  • Individuals, communities, and governments
  • UN agencies
  • Multilateral and bilateral development organisations
  • International partnerships
  • Foundations
  • National research and health oversight organisations
  • Universities
  • Consulting firms
  • Product development partnerships
  • Pharmaceutical firms
  • Non-governmental organisations